title: Outlet constipation 1 year after robotic sacrocolpopexy with and without concomitant posterior repair.
abstract: OBJECTIVE
  The aim of this study was to estimate the rate of outlet constipation at 1 year after robotic sacrocolpopexy (RSCP) with and without a concomitant distal posterior repair (PR). We sought, first, to determine the rate of persistent outlet constipation and second, to determine de novo outlet constipation.
  
  
  METHODS
  This was a cohort study of women who underwent RSCP alone versus RSCP + PR, at each surgeon's discretion, between November 2007 and February 2011 at an academic center. Specific questions in the Pelvic Floor Distress Inventory Short Form correlating to outlet constipation and its colorectal-anal subscale scores were compared between and within groups. Rates of posterior compartment reoperation were assessed.
  
  
  RESULTS
  Of the 77 women who underwent RSCP, 21 (27%) had a concomitant distal PR. Overall, there was significant improvement in pelvic floor function and quality of life at 1 year after surgery (P = 0.01). Preoperatively, outlet constipation was present in 63.4% of those who underwent RSCP only and in 53.3% of those with concomitant PR. Postoperatively at 1 year, 56% of preoperative outlet constipation resolved and 44% persisted (P = 0.001), with no differences between groups (RSCP vs RSCP + PR). The rate of postoperative de novo outlet constipation was 13.6%. At 1 year after RSCP, 18.2% of patients had symptomatic posterior prolapse, with no difference between both groups (P = 0.746). Overall, 11.7% underwent a subsequent PR, none of whom underwent PR with the initial RSCP (P = 0.104).
  
  
  CONCLUSIONS
  At 1 year after RSCP, there was a high rate of persistent outlet constipation and a moderate rate of de novo outlet constipation. Concomitant PR did not significantly affect these bowel symptoms.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA. andrea_crane@med.unc.edu
authors.forename: Andrea Kuntaraf
authors.initials: AK
authors.lastname: Crane
authors.forename: Elizabeth Joanne
authors.initials: EJ
authors.lastname: Geller
authors.forename: Catherine Ann
authors.initials: CA
authors.lastname: Matthews
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D012371:Robotics; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery